The outcome of acute renal failure in the intensive care unit according to RIFLE: Model application, sensitivity, and predictability
The outcome of acute renal failure in the intensive care unit according to RIFLE: Model application, sensitivity, and predictability
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DOI：
10.1053/j.ajkd.2005.08.033
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发表时间：
2005-12-01
影响因子：
13.2
通讯作者：
El Nahas, AM
中科院分区：
文献类型：
--
作者：
Abosaif, NY;Tolba, YA;El Nahas, AM
背景：重症监护病房（ICU）中急性肾衰竭（ARF）的定义、分类和治疗选择仍然是争论的话题。为了改进我们在 ICU 中处理 ARF 的方法，我们回顾性应用了急性透析质量倡议小组提出的 ARF 新分类 RIFLE（缩写词，表示肾衰竭风险、肾损伤、肾功能衰竭、肾功能丧失和终末期肾衰竭），以评估其预测肾脏和患者结局的敏感性和特异性。方法：RIFLE 分类适用于 2002 年至 2003 年英国谢菲尔德北部综合医院 ICU 收治的 183 名 ARF 患者。根据肾小球滤过率较基线下降的百分比，将患者分为 4 组。风险组包括60名患者；损伤组56例；失败组43例；对照组24例。对 4 组的人口统计学、生化、血液学、临床和长期健康状况进行了研究和比较。尝试通过逻辑回归分析和接受者操作特征曲线分析来评估RIFLE分类对ICU死亡率的预测价值。结果：失败组在急性生理学和慢性健康评估（APACHE）II评分、pH、最低和最高平均动脉压以及格拉斯哥昏迷量表方面表现出最差的参数（P < 0.001）。与所有组相比，失败组的 ICU 死亡率（1 个月）显着高于所有组（43 名患者中的 32 名 [74.4%]；P < 0.001），并且 6 个月死亡率（43 名患者中的 37 名 [86%]；P < 0.001）。受试者操作者特征曲线分析显示，与失败组和对照组相比，简化急性生理学评分（SAPS）II对风险组和损伤组患者死亡的预测比APACHE II评分更敏感（风险组：SAPS II，0.8 +/- 0.06；P < 0.001；APACHE II，0.63 +/- 0.07；P = 0.14；损伤组：SAPS II， 0.76+/-0.08；P<0.001； 阿帕奇 II，0.72 +/- 0.07； P = 0.006）。结论：RIFLE 分类可以提高 APACHE II 和 SAPS II 等较早建立的 ICU 评分系统预测 ICU ARF 患者预后的能力。
Background: The definition, classification, and choice of management of acute renal failure (ARF) in the setting of the intensive care unit (ICU) remain subjects of debate. To improve our approach to ARF in the ICU setting, we retrospectively applied the new classification of ARF put forward by the Acute Dialysis Quality Initiative group, RIFLE (acronym indicating Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal failure), to evaluate its sensitivity and specificity to predict renal and patient outcomes. Methods: RIFLE classification was applied to 183 patients with ARF admitted to the ICU (2002 to 2003) at the Northern General Hospital, Sheffield, UK. Patients were divided into 4 groups according to percentage of decrease in glomerular filtration rate from baseline. The risk group included 60 patients; injury group, 56 patients; failure group, 43 patients; and control group, 24 patients. Demographic, biochemical, hematologic, clinical, and long-term health status were studied and compared in the 4 groups. An attempt was made to evaluate, by means of logistic regression analysis and receiver operator characteristic curve analysis, the predictive value of RIFLE classification for mortality in the ICU. Results: The failure group showed the worst parameters with regard to Acute Physiology and Chronic Health Evaluation (APACHE) II score, pH, lowest and highest mean arterial pressures, and Glasgow Coma Scale (P < 0.001). Mortality rate in the ICU (1 month) was significantly greater in the failure group compared with all groups (32 of 43 patients [74.4%]; P < 0.001) and, again, 6-month mortality rate (37 of 43 patients [86%]; P < 0.001). Receiver operator characteristic curve analysis showed that Simplified Acute Physiology Score (SAPS) II was more sensitive than APACHE II score for prediction of patient death in the risk and injury groups compared with the failure and control groups (risk group: SAPS II, 0.8 +/- 0.06; P < 0.001; APACHE II, 0.63 +/- 0.07; P = 0.14; injury group: SAPS II, 0.76 +/- 0.08; P < 0.001; APACHE II, 0.72 +/- 0.07; P = 0.006). Conclusion: RIFLE classification can improve the ability of such older and established ICU scoring systems as APACHE II and SAPS II in predicting outcome of ICU patients with ARF.